Students Lead Charge to Make Microscope Exchange International Lab Project a Reality

In today’s high-tech society, even the formerly essential microscope has become somewhat obsolete, but not so in resource-poor countries, where a single microscope can serve as the seed for a potential lifesaving diagnostic laboratory. Third-year University of Vermont medical students Adam Ackerman and Peter Cooch created The Microscope Exchange (TME) to create a pipeline that brings microscopes, laboratory skills training and manuals to countries like Guatemala and Haiti.

Diagnostic laboratories are primarily clinical and used for the diagnosis of disease, but can also function as data collection sites. Using laboratory techniques and technology helps ensure a more accurate diagnosis and treatment. According to Ackerman and Cooch, “Studies show that one microscope can significantly change diagnosis and treatment.” In one study of cases in Tanzania, out of about 4,500 patients treated for malaria, only 46.1 percent had malaria; the rest had other conditions, like bacterial sepsis, that had been misdiagnosed.

The two medical students, who are mentored by Majid Sadigh, M.D., director of Global Health at the UVM College of Medicine’s clinical teaching partner Danbury Hospital/Western Connecticut Health Network, learned that “simply bringing a microscope into an established clinic changed everything 180 degrees.” However, they also determined that there is a lack of supplies and training to gain the necessary skills to conduct lab tests using microscopes. Among their objectives is to distribute microscopes – several dozen of which they have received via College of Medicine Senior Associate Dean for Medical Education William Jeffries, Ph.D. – and others from the UVM/Fletcher Allen Department of Pathology, create a lab manual that is region-specific, and provide the new laboratory sites with funding.

With assistance from Sadigh, they have developed a relationship with physicians at Makerere University in Kampala, Uganda, via email communication, and have been invited to set up labs in strategic locations throughout that country.

Over the past several months, first- and second-year UVM medical students have participated in a series of basic microscopy and laboratory techniques sessions in conjunction with the project. First, Cooch and Ackerman led a basic microscopy session reviewing the parts of the microscope and trained their fellow students in tissue examination approaches. At a second session, Christine Griffin, M.S., senior lecturer in medical laboratory and radiation sciences in the UVM College of Nursing and Health Sciences, taught students how to make peripheral blood smears – something they do not get to do in medical school. The participating students returned a week later to learn how to interpret the slides they made on the microscopes. Mary Tang, M.D., associate professor of pathology, who trained Cooch in blood smear and diagnostic techniques, and Abiy Ambaye, M.D., associate professor of pathology, have assisted with this training effort.

“I came away so empowered with these techniques,” says Cooch, who has volunteered at clinics in Guatemala prior to and during medical school. Ackerman, who was a classical musician before learning laboratory techniques at Massachusetts General Hospital (MGH) in Boston prior to coming to UVM, agrees. “These simple laboratory techniques give us a world of information about our patients,” he says. “If you’re working overseas with limited resources, being able to do a blood smear on your own is invaluable.”

The next training session, which is tentatively planned for February 2013, will focus on how to perform fine needle aspirate (FNAs) – drawing out cells for examination under a microscope – and will be led by Ambaye. Students will learn this technique by either working with cadavers or using a simulated method that will allow them to practice the procedure and analyze the cells. Medical students and residents are eligible to apply for a microscope from TME and use the techniques they have learned to set up laboratories.

“UVM medical students and residents may be able to travel to labs around the world to share their technical skills and bring needed equipment and reagents, which will foster retention of the onsite technicians,” says Cooch.

In the meantime, Ackerman is working on gaining access to cytogenetics (fluorescence microscopes), and he and Cooch will be co-authoring (with Ackerman’s former MGH mentor, Dr. Aliyah Sohani) a chapter on essential laboratory skills for global health for a textbook being published by Wiley-Blackwell as part of their Essentials series. The lab manual, which is being worked on with pathology faculty, “will be heavy on photos and pictures, and simplified and translated so that everyone can understand it,” says Ackerman. UVM medical students, led by second-year medical student Elizabeth Landell, have also been assisting with conducting a literature review regarding setting up labs in resource-poor regions.

Cooch and Ackerman plan to travel to Haiti in March 2013 and then spend a month in Uganda during their fourth year of medical school. Any spare time they can find while in the middle of clinical rotations is spent soliciting more donations of lab materials and funding from outside institutions. In addition, the TME has a website, developed by first-year medical students Taylor Goller and Colette Oesterle, and Cooch and Ackerman have applied for a 503c tax ID number so that The Microscope Exchange is eligible to receive financial gifts to help propel the program – and its mission – forward.